Systematic review of chronic ankle instability in children

A Home-Based Exercise Program With Active Video Games for Balance, Motor Proficiency, Foot and Ankle Ability, and Intrinsic Motivation in Children With Chronic Ankle Instability: Feasibility Randomized Controlled Trial

Background

Children with chronic ankle instability (CAI) frequently experience ankle unsteadiness, causing trips, falls, and ankle sprain injuries resulting in poor quality of life. A specific exercise program focused on physical and psychological purposes in children with CAI is needed.

Objective

The purpose of this study was to investigate the feasibility of a 4-week home-based exercise training program using active video games (AVGs) for balance, motor proficiency, foot and ankle ability, and intrinsic motivation in children with CAI.

Methods

Sixty children with CAI (mean age 10, SD 2 years) were randomly assigned to an experimental group (AVG group; n=30) or a control group (CG; n=30). The AVG group played 2 selected video games, Catching Fish and Russian Block, while the CG received the traditional exercise program for CAI. Both programs were scheduled for 30 minutes per day, 3 times per week, for 4 weeks at home. The single-leg stance test was used to assess static balance. The walking forward on a line and standing long jump tests were used to assess motor proficiency. The Foot and Ankle Ability Measure (FAAM) and the Intrinsic Motivation Inventory questionnaire were used to assess foot and ankle ability and intrinsic motivation, respectively. Assessments were conducted at baseline and after 4 weeks.

Results

In the AVG group, the single-leg stand test (eyes open; on floor and on foam conditions), the FAAM (activities of daily living subscale), and intrinsic motivation (interest/enjoyment, pressure/tension, and value/usefulness dimensions) were improved compared with the CG (all P<.05). Motor proficiency did not differ between the 2 groups at the end of the 4-week program (P=.31 for the walking forward on a line, P=.34 for the standing long jump test).

Conclusions

A 4-week home-based exercise training program using AVGs can be beneficial and may be an effective approach for improving balance, foot and ankle ability, and enhancing positive motivation by increasing the interest/enjoyment and value/usefulness dimensions and lowering the pressure/tension dimension in children with CAI that require long-term rehabilitation sessions.

Relationship of Chronic Ankle Instability With Foot Alignment and Dynamic Postural Stability in Adolescent Competitive Athletes

Background

Competitive adolescent athletes should be aware of the early signs of chronic ankle instability (CAI) and the connection between the condition and performance.

Purpose

To investigate whether CAI is related to foot alignment and morphology as well as dynamic postural stability after a jump landing among adolescent competitive athletes with and without a history of a lateral ankle sprain and CAI.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Between July 2020 and August 2021, adolescent competitive athletes (N = 85; n = 49 boys; n = 36 girls) were classified into 3 groups using Cumberland Ankle Instability Tool (CAIT) scores: healthy athletes (n = 55), coper athletes (n = 19), and athletes with CAI (n = 11). Results of foot alignment assessments involving the leg-heel angle (LHA) and navicular height, intrinsic foot muscle morphology, dynamic postural stability index (DPSI), and other parameters were compared among the 3 groups. The relationship between the CAIT score and the LHA and dynamic postural stability and instability were examined using multiple linear regression.

Results

Compared with the healthy group, the CAI group had a significantly greater LHA (8.73°± 3.22° vs 6.09°± 3.26°; P < .05), higher DPSI (0.336 ± 0.046 vs 0.298 ± 0.035), and higher vertical stability index (0.303 ± 0.048 vs 0.264 ± 0.037; P < .05 for all). Multiple regression analysis showed that the LHA (β = -0.228; P = .033) and DPSI (β = -0.240; P = .025) were significantly associated with the CAIT score .

Conclusion

Valgus rearfoot alignment and poorer dynamic postural control were associated with CAI among adolescent athletes.

Current concepts in the surgical management of chronic ankle lateral ligament instability

Background/aims

Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI).

Methods

The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI.

Results

Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes.

Conclusion

Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.

The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

Background

Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.

Methods

An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.

Results

After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.

Conclusions

The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.

In Pursuit of the Perfect Dancer's Ballet Foot. The Footprint, Stabilometric, Pedobarographic Parameters of Professional Ballet Dancers

This work aims to assess footprint parameters in a group of professional ballet dancers and to determine the correlation between the aforementioned parameters and lateralization, stabilometric parameters, pedobarographic parameters and work environment conditions. A group subjected to tests consisted of 44 elite professional ballet dancers and the reference group was composed of 44 students. The test of balance and thrust under feet involved 30 s-long free standing with open eyes on a podographic platform. The research-related analysis was concerned with footprint parameters (foot length and width, Clarke angle, and Weissflog index), stabilometric parameters (path length and ellipse field, mean value of the velocity and deflection of the displacement of the center of the foot pressure on the ground) and pedobarographic parameters (percentage thrust on the right, left foot as well as the front and rear part the foot). Statistically significant differences between the groups were observed in relation to the stabilometric parameters, the percentage pressure of the left forefoot and the right heel, as well as the value of the Clarke angle (p ≤ 0.05). The longitudinal arch of the foot and the width of the foot in ballet dancers are not dependent on the total and professional career duration and weekly training volume.

Lateral Ankle Sprains and Their Association with Physical Function in Young Soccer Players

Purpose

Lateral ankle sprain (LAS) in childhood can result in lateral malleolus avulsion fractures; additionally, bone nonunion may occur. Physical maturity relates to the development of bone morphology and physical functionality. It is unknown how changes in physical functionality attributable to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels.

Subjects and Methods

Two hundred and ninety young soccer players aged 6–15 years were included. The presence of ALM was assessed using ultrasonography. The subjects were allocated to three groups based on physical maturity (Pre-, Mid-, and Post-peak height velocity age [PHVA]). The prevalence of ALM and the relationship between ALM and physical maturity were examined for body composition, foot pressure distribution, foot alignment, ankle mobility, and single-leg balance.

Results

The prevalence of ALM was 17.6%. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the Pre-PHVA group (P < 0.05). In the ALM group, the center of pressure during heel raising was distributed laterally in the Post-PHVA (P < 0.01), and the weight-bearing dorsiflexion angle was decreased in the Mid- and Post-PHVA (P < 0.05).

Conclusion

In the Post-PHVA young soccer players, decreased ankle dorsiflexion and eversion and increased one-leg hop distance were observed. The ALM group exhibited lateral loading during heel raising in the Post-PHVA group and decreased weight-bearing ankle dorsiflexion angle in the Mid- and Post-PHVA groups. The findings indicate the importance of secondary prevention of LAS and ultrasonography. Prospective studies of LAS in young athletes are required in the future.

Four-Week Ankle-Rehabilitation Programs in Adolescent Athletes With Chronic Ankle Instability

CONTEXT

Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown.

OBJECTIVE

To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI.

DESIGN

Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652).

SETTING

High school athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups.

INTERVENTION(S)

Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises.

MAIN OUTCOME MEASURE(S)

Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different.

RESULTS

Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P < .05). However, no intervention group was superior.

CONCLUSIONS

All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

Cross-cultural adaptation of the Cumberland Ankle Instability Tool - Youth Thai version

BACKGROUND

This study aimed to translate the original version of the Cumberland Ankle Instability Tool (CAITY) into a Thai version by using cross-cultural adaptation, and to examine the psychometric properties and cut-off score of the CAITY - Thai version (CAITY-T).

METHODS

Six cross-cultural adaptation steps were used to translate and validate the psychometric properties with 267 participants, 140 with chronic ankle instability (CAI) and 127 without CAI. Their mean age was 12.3 ± 2.42 years. Validation was carried out for internal consistency and concurrent validity against a visual analog scale for global perceived ankle instability, and for discriminant validity (receiver operating characteristic curve). The CAITY-T was completed twice by 133 volunteer children (49.62%) for test-retest reliability. The cut-off score was determined using Youden's index.

RESULTS

The CAITY was successfully adapted for the Thai language. Validation showed good internal consistency (Cronbach's α = 0.767) and concurrent validity (Pearson correlation coefficient = 0.8 right ankle and 0.784 left ankle). The test-retest reliability was substantial with an intraclass correlation coefficient (2,1) of 0.865 (95% Confidence Interval = 0.809-0.904). The receiver operating characteristic curve and Youden's index showed the cut-off score that discriminated between children with and without CAI on the CAITY-T at ≤25. The CAITY-T obtained 95.2% sensitivity, 97% specificity, 0.05 negative, and 32 positive likelihood ratios.

CONCLUSION

The CAITY-T was valid and available for Thai children aged 8-16 years. It displayed positive reliability, good validity, and an acceptable cut-off score. The cut-off score for children had high sensitivity, specificity, and positive and negative likelihood ratios.

Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes

Background:

The prevalence and impact of chronic ankle instability (CAI) in adolescent athletes are unknown. To better develop and justify prevention strategies of lateral ankle sprains and CAI, it is important to understand the origin and associated long-term impact of CAI within populations other than adults.

Purpose/Hypothesis:

The purpose of this study was to determine the prevalence and impact of CAI on ankle function, health-related quality of life (HRQoL), and physical activity in adolescent athletes. The hypothesis was that the presence of CAI will be commonly reported among adolescent athletes and that participants with CAI will have lower self-reported ankle function, HRQoL, and physical activity when compared with participants without CAI.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A cohort of 1002 healthy (able to fully participate) adolescent athletes (50.4% female; mean age, 15.6 ± 1.6 years) across 8 club sport facilities and high schools completed paper-and-pencil surveys to establish the presence of CAI (Identification of Functional Ankle Instability [IdFAI]) and estimate perceived ankle function (Foot and Ankle Ability Measure [FAAM]–Activities of Daily Living and FAAM-Sport), HRQoL (Pediatric Quality of Life Inventory 4.0 [PedsQL]), and physical activity (Hospital for Special Surgery Pediatric Functional Activity Brief Scale [HSS Pedi-FABS]).

Results:

The overall prevalence of CAI was 20.0%. Participants with unilateral CAI reported significantly lower (P < .001) ankle function (FAAM-Sport: 87.0 ± 14.8) and HRQoL (total PedsQL: 89.8 ± 9.8) than participants who did not have CAI (FAAM-Sport: 97.7 ± 6.0; total PedsQL: 93.5 ± 9.1). Physical activity was not different between participants with and without CAI.

Conclusion:

The prevalence of CAI was high among adolescent athletes. The presence of CAI negatively affected ankle function and HRQoL in adolescent athletes. Given the high prevalence and negative impact of CAI in an adolescent population, strategies to prevent ankle injuries and maintain physical activity are needed to alleviate future long-term consequences associated with developing CAI. These strategies should be implemented as soon as sport participation begins, as it appears that the origin of CAI may occur before adulthood.

Quantifying Age-Related Differences of Ankle Mechanical Properties Using a Robotic Device

A deep analysis of ankle mechanical properties is a fundamental step in the design of an exoskeleton, especially if it is to be suitable for both adults and children. This study aims at assessing age-related differences of ankle properties using pediAnklebot. To achieve this aim, we enrolled 16 young adults and 10 children in an experimental protocol that consisted of the evaluation of ankle mechanical impedance and kinematic performance. Ankle impedance was measured by imposing stochastic torque perturbations in dorsi-plantarflexion and inversion-eversion directions. Kinematic performance was assessed by asking participants to perform a goaldirected task. Magnitude and anisotropy of impedance were computed using a multipleinput multiple-output system. Kinematic performance was quantified by computing indices of accuracy, smoothness, and timing. Adults showed greater magnitude of ankle impedance in both directions and for all frequencies, while the anisotropy was higher in children. By analyzing kinematics, children performed movements with lower accuracy and higher smoothness, while no differences were found for the duration of the movement. In addition, adults showed a greater ability to stop the movement when hitting the target. These findings can be useful to a proper development of robotic devices, as well as for implementation of specific training programs.

Intrinsic modifiable risk factors in ballet dancers: Applying evidence based practice principles to enhance clinical applications

INTRODUCTION

The risk of musculoskeletal injury is multifactorial (Bahr 2005). Injury risk is a composite of intrinsic and extrinsic risk factors that can be modifiable or non-modifiable. Ballet dancers have unique risk factors, due to the nature of their art and sport. The purpose of this literature review is to identify intrinsic modifiable risk factors for injury in ballet dancers. The secondary purpose is to investigate potential screening tools which can be used to identify these risk factors.

METHODS

The authors performed a review of the literature in October 2017 within the databases of MEDLINE Complete, SPORTDiscus, and PubMed Central following a list of inclusion and exclusion criteria.

RESULTS

A review of the available literature identified seven intrinsic modifiable factors specifically for ballet dancers and seven appropriate screening tools.

DISCUSSION

The literature identified the most common intrinsic modifiable risk factors associated with ballet dancers to be: hypermobility, fatigue, overuse, neuromuscular dysfunction, degree of turnout, weakness of core and lower extremity musculature, and lower extremity range of motion (ROM) discrepancies.

CONCLUSION

Sports medicine professionals who manage these performing artists can use this literature review to help develop injury prevention programs and enhance return to sport decision.

Pediatric and adolescent ankle instability: diagnosis and treatment options

PURPOSE OF REVIEW

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and treatment for lateral ankle instability in pediatric patients.

RECENT FINDINGS

Chronic ankle instability is a common sequela of lateral ankle sprain in young athletes. Incidence is increasing, possibly due in part to inadequate treatment of first-time ankle sprains, as well as increased youth participation in organized and competitive sports. The anterior talofibular ligament (ATFL) is injured in every case, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases. A clinical history, focused physical exam, and appropriate radiographic studies aid in diagnosis, and predisposing factors must be identified. Early treatment of ankle sprains involves bracing or immobilization, followed by a course of physical therapy. Surgery involves anatomic repair of the torn ligaments, and may be required in cases of severe functional and mechanical instability with recurrent sprains refractory to nonsurgical management. Intraarticular disorders should be identified and may be addressed with ankle arthroscopy.

SUMMARY

Prompt treatment of lateral ankle instability in young athletes is important to prevent chronic ankle instability. Many patients are successfully treated without surgery, and those requiring operative intervention improve function postoperatively.

Functional performance tests identify lateral ankle sprain risk: A prospective pilot study in adolescent soccer players

Determining the clinical utility of functional performance tests (FPTs) and establishing cutoff scores could be useful in identifying those athletes who could benefit from effective injury prevention interventions. Our purpose was to determine the accuracy of FPTs in identifying adolescent athletes who go on to experience lateral ankle sprain(s) and establish specific cutoff scores capable of identifying those who sustain a lateral ankle sprain in the near future. Sixty-four participants (age = 15.5 ± 1.3 years; height = 161.7 ± 7.7 cm; mass = 57.1 ± 8.4 kg) were recruited from a junior soccer club and tracked for 10 months. Participants performed the anterior (AN), posterior-medial (PM), and posterior-lateral (PL) reach directions of the Star Excursion Balance Test (SEBT) and the Single-Leg Hop Test (SLHT) in pre-season, and then were followed for the 10-month competitive season (12 injured, 52 uninjured). Significant Area Under the Curve (AUC) values and cutoff scores were found for the PM (AUC = 0.78; 95% CI 0.61-0.95; P = 0.003; Sn = 0.83; Sp = 0.77; cutoff = 76%) and the PL (AUC = 0.82; 95% CI 0.71-0.94; P = 0.001; Sn = 0.92; Sp = 0.65; cutoff = 70%) reach directions of the SEBT and the SLHT (AUC = 0.77; 95% CI 0.60-0.95; P = 0.003; Sn = 0.67; Sp = 0.94; cutoff = 15.4 seconds). The PM and PL reach directions of the SEBT and the SLHT may be useful as pre-season screening measures to help clinicians identify adolescents who will go on to experience a lateral ankle sprain.

Functional performance deficits in adolescent athletes with a history of lateral ankle sprain(s)

OBJECTIVE

To determine if adolescent athletes with a history of lateral ankle sprain(s) (LAS) displayed deficits on functional performance tests (FPTs) and if deficits on FPT were related to the number of previous LAS.

DESIGN

Cross-sectional study.

SETTING

Biomechanics Laboratory.

PARTICIPANTS

The injured group (n = 24) had a history of ≥1 moderate-severe LAS. The uninjured group (n = 34) had no history of LAS.

MAIN OUTCOME MEASURE(S)

The average reach distance of three trials in each direction of the star excursion balance test (SEBT) was normalized to leg length (%). The average of two trials of single-leg-hop test (SLHT) was calculated in seconds.

RESULTS

The injured group performed significantly worse in 3 directions of SEBT than the uninjured group (P < 0.05). SLHT was significantly slower in the injured group compared to the uninjured group (P < 0.05). Statistically significant, strong to moderate inverse relationships were found between the numbers of LAS and each of the three directions of the SEBT (P ≤ 0.01). No relationship was revealed between the number of LAS and the SLHT (P > 0.05).

CONCLUSION(S)

Adolescent athletes with a history of LAS exhibit functional performance deficits on the SEBT and SLHT. Therefore, the SEBT and SLHT may provide clinicians cost- and time-effective objective tools.

Lateral Ankle Sprain in a Mouse Model: Lifelong Sensorimotor Dysfunction

CONTEXT

  Ankle sprains are the most common orthopaedic injury that occurs during sport and physical activity. Many individuals who sprain their ankles develop chronic ankle instability (CAI), a condition characterized by recurrent injury, decreased physical activity, and decreased quality of life. These residual impairments are believed to persist for the remainder of the patient's life, in part due to the link between CAI and posttraumatic ankle osteoarthritis. However, this belief remains speculative due to the lack of long-term prospective investigations.

OBJECTIVE

  To use a mouse model of mild (MILD) and severe (SEVERE) ankle sprains to quantify balance and locomotor adaptations across the lifespan.

DESIGN

  Cohort study.

SETTING

  University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Fifty male mice (CBA/J) were randomly placed into a control (SHAM), MILD, or SEVERE group and housed individually.

INTERVENTION(S)

  The MILD group underwent surgical transection of a single right hind-limb lateral ankle ligament, and the SEVERE group had 2 of the lateral ligaments transected. The SHAM group underwent a sham surgery during which no lateral ligaments were transected.

MAIN OUTCOME MEASURE(S)

  After surgically inducing the ankle sprain, we measured balance and gait using a balance beam and footprint test before and every 6 weeks for 78 weeks.

RESULTS

  Age-related declines in balance but not stride length were exacerbated by an ankle sprain ( P < .001). Balance and stride lengths changed with age ( P < .001). Foot slips were worse in the SEVERE (4.32 ± 0.98) and MILD (3.53 ± 0.98) groups than in the SHAM group (2.16 ± 0.99; P < .001). Right-limb stride length was shorter in the SEVERE group (6.45 cm ± 0.41 cm) than in the SHAM group (6.87 cm ± 0.40 cm; P = .04).

CONCLUSIONS

  Transecting the lateral ligaments of a mouse hind foot resulted in lifelong sensorimotor dysfunction. Declines starting at 42 weeks postinjury may have represented the onset of posttraumatic osteoarthritis.

Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study

Background

Recent evidence suggests that impaired central sensorimotor integration may contribute to deficits in movement control experienced by people with chronic ankle instability (CAI). This study compared the effects of dual-task and walking speed on gait variability in individuals with and without CAI.

Methods

Sixteen subjects with CAI and 16 age- and gender-matched, able-bodied controls participated in this study. Stride time variability and stride length variability were measured on a treadmill under four different conditions: self-paced walking, self-paced walking with dual-task, fast walking, and fast walking with dual-task.

Results

Under self-paced walking (without dual-task) there was no difference in stride time variability between CAI and control groups (P = 0.346). In the control group, compared to self-paced walking, stride time variability decreased in all conditions: self-paced walking with dual-task, fast speed, and fast speed with dual-task (P = 0.011, P = 0.016, P = 0.001, respectively). However, in the CAI group, compared to self-paced walking, decreased stride time variability was demonstrated only in the fast speed with dual-task condition (P = 1.000, P = 0.471, P = 0.008; respectively). Stride length variability did not change under any condition in either group.

Conclusions

Subjects with CAI and healthy controls reduced their stride time variability in response to challenging walking conditions; however, the pattern of change was different. A higher level of gait disturbance was required to cause a change in walking in the CAI group compared to healthy individuals, which may indicate lower adaptability of the sensorimotor system. Clinicians may use this information and employ activities to enhance sensorimotor control during gait, when designing intervention programs for people with CAI.

The study was registered with the Clinical Trials network (registration NCT02745834, registration date 15/3/2016).

Predicting balance improvements following STARS treatments in chronic ankle instability participants

OBJECTIVES

Sensory Targeted Ankle Rehabilitation Strategies that stimulate sensory receptors improve postural control in chronic ankle instability participants. However, not all participants have equal responses. Therefore, identifying predictors of treatment success is needed to improve clinician efficiency when treating chronic ankle instability. Therefore, the purpose was to identify predictors of successfully improving postural control in chronic ankle instability participants.

DESIGN

Secondary data analysis.

METHODS

Fifty-nine participants with self-reported chronic ankle instability participated. The condition was defined as a history of at least two episodes of "giving way" within the past 6 months; and limitations in self-reported function as measured by the Foot and Ankle Ability Measure. Participants were randomized into three treatment groups (plantar massage, ankle joint mobilization, calf stretching) that received 6, 5-min treatment sessions over a 2-week period. The main outcome measure was treatment success, defined as a participant exceeding the minimal detectable change score for a clinician-oriented single limb balance test.

RESULTS

Participants with ≥3 balance test errors had a 73% probability of treatment success following ankle joint mobilizations. Participants with a self-reported function between limb difference <16.07% and who made >2.5 errors had a 99% probability of treatment success following plantar massage. Those who sustained ≥11 ankle sprains had a 94% treatment success probability following calf stretching.

CONCLUSIONS

Self-reported functional deficits, worse single limb balance, and number of previous ankle sprains are important characteristics when determining if chronic ankle instability participants will have an increased probability of treatment success.

Altered left ventricular performance in aging physically active mice with an ankle sprain injury

We assessed the impact of differing physical activity levels throughout the lifespan, using a musculoskeletal injury model, on the age-related changes in left ventricular (LV) parameters in active mice. Forty male mice (CBA/J) were randomly placed into one of three running wheel groups (transected CFL group, transected ATFL/CFL group, SHAM group) or a SHAM Sedentary group (SHAMSED). Before surgery and every 6 weeks after surgery, LV parameters were measured under 2.5 % isoflurane inhalation. Group effects for daily distance run was significantly greater for the SHAM and lesser for the ATLF/CFL mice (p = 0.013) with distance run decreasing with age for all mice (p < 0.0001). Beginning at 6 months of age, interaction (group × age) was noted with LV posterior wall thickness-to-radius ratios (h/r) where h/r increased with age in the ATFL/CFL and SHAMSED mice while the SHAM and CFL mice exhibited decreased h/r with age (p = 0.0002). Passive filling velocity (E wave) was significantly greater in the SHAM mice and lowest for the ATFL/CFL and SHAMSED mice (p < 0.0001) beginning at 9 months of age. Active filling velocity (A wave) was not different between groups (p = 0.10). Passive-to-active filling velocity ratio (E/A ratio) was different between groups (p < 0.0001), with higher ratios for the SHAM mice and lower ratios for the ATFL/CFL and SHAMSED mice in response to physical activity beginning at 9 months of age. Passive-to-active filling velocity ratio decreased with age (p < 0.0001). Regular physical activity throughout the lifespan improved LV structure, passive filling velocity, and E/A ratio by 6 to 9 months of age and attenuated any negative alterations throughout the second half of life. The diastolic filling differences were found to be significantly related to the amount of activity performed by 9 months and at the end of the lifespan.